Individual
JAX ROMAN FLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1827 NE 44TH AVE, PORTLAND, OR 97213-1443
(503) 963-6494
Mailing address
1450 N PRESCOTT ST APT 320, PORTLAND, OR 97217-3206
(801) 854-8865
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
ABA-IN-10245553
OR
Other
Enumeration date
07/13/2024
Last updated
07/13/2024
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